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- Secure Form -
PRIVATE WINE CLUB SIGNUP
We are pleased to honor and reward those who love our wines and the unique story of our Domaine. As a DCC club member, you will become a special part of the DCC family and enjoy two wine collection releases per year -- May & October -- with our finest wines delivered from our Domaine to your door -- with shipping included.
Please indicate your desired Club membership by selecting a box below:
*
BLANC -- 2 bottles of DCC wines each shipment -- $195 per shipment
BLEU -- 4 bottles of DCC wines each shipment -- $395 per shipment
DORÉ -- 6 bottles of DCC wines each shipment -- $595 per shipment
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Referred by / Comments
Billing Address 1
*
Billing Address 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Yes
No
Is your shipping address different than your billing address?
*
Shipping Address 1
*
Shipping Address 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Name on Credit Card
*
Credit Card Type
*
Visa
MasterCard
American Express
Discover
Credit Card Number
*
Expiration Date (mm/yy)
*
Our next shipment of wine is estimated around May 15th. We will send an email confirmation with the details of your club membership shortly!
Thank you for your interest and support,
Mark O'Connell
Domaine Clos de la Chapelle
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